obstetrics and gynecology

While it would be a huge relief for a patient to find out a growth in her breast is noncancerous, she might still require follow-up care. That’s where Dr. Dana Scott comes in.

Scott, who recently joined UConn Health’s obstetrics and gynecology team at the Charlotte Johnson Hollfelder Center for Women’s Health, specializes in breast health and cancer genetics. In addition to providing routine OB/GYN care, Scott is referred patients who have breast issues that aren’t cancer.

These might include breast pain, breast infections, noncancerous lumps, and fibroadenomas. Some patients with benign breast disease may need an excision while others simply need continuing check-ups. Additionally, she sees patients at high risk for breast and gynecologic malignancies due to their family history and/or a genetic mutation.

“Benign breast disease is a common issue that arises, but it’s not something that typically has received a lot of focus in medical care,” Scott says.

Being able to develop a benign breast disease program, which is unique in the area, drew Scott to UConn Health, she says. “The chair of my department [Dr. Molly Brewer] was very open-minded and eager to have someone with a different background and training. The surgical oncologist [Dr. Christina Stevenson] was very open to working with me and developing a mechanism for women with benign breast diseases to receive care.”

As part of an American College of Obstetrics and Gynecology committee, Scott is working to develop new screening guidelines for those at risk for early-onset breast cancer, with funding from the Centers for Disease Control and Prevention.

Scott stresses that it is important for OB/GYN and primary care doctors to get good family histories from patients. They should also lower their threshold for referring patients to a genetic counselor.

“Genetic testing for risks of breast, ovarian, and other cancers has become a lot more accessible and affordable,” she says.

In addition to her unique background, patients will find a listening ear in Scott.

“I try to really listen to my patients and spend the appropriate amount of time with them to hear their concerns,” she says. “Especially with the breast patients, a lot of them are really worried that they have breast cancer, and when they learn they don’t, having someone who can listen to them, thoroughly examine them, and provide follow-up and reassurance is really important.”

Women doctors were a rarity in the U.S. until just a few decades ago, and it wasn’t easy for a woman seeking a female obstetrician or general practitioner to find one. But times have changed — women surgeons, doctors, and health care practitioners of all sorts are everywhere.

At UConn Health, we’re proud to have an army of women caring for women in every specialty, as doctors, therapists, and nurses. Many have advanced degrees and research projects in addition to their clinical work.

We spoke to just a few of the many, many women who do research and provide clinical care for other women at UConn Health. We asked them why they do what they do, how caring for women is different than caring for men, and anything else they thought was important. This is what they said.

Gynecological Surgery

I need you to take it easy for just one week.

Dr. Danielle Luciano’s patients are usually younger women with pelvic pain or unmanageable periods related to uterine fibroids or endometriosis. Luciano tries medical treatments with the women first. If that doesn’t work, she offers minimally invasive surgery that solves the pain while sparing her patients’ fertility.

Dr. Danielle Luciano cares for women throughout their lifespans.

“As an OB/GYN, I take care of my patients throughout their lifespan. I might remove their endometriosis when they are young,” and help them in menopause too. As a fellow woman, she can relate to her patients and perhaps give them more convincing advice than a male doctor might.

“I’ve had some babies, and I’ve had to have some things fixed afterwards, so I know where they’re coming from,” Luciano says. “I can say, ‘Look, I know you’re going to go home and try to do 1,000 things. But I need you to take it easy for just one week.’”

Fibroids and endometriosis affect a lot of women, around 10 percent. Oftentimes these conditions run in families, and a mom may normalize it when her daughter suffers, explaining the same thing happened to her. But if a woman has miserable periods with such heavy bleeding, terrible pain, or gastrointestinal symptoms that she can’t work or go to school, there could be something wrong that Luciano can help with.

Professions sometimes run in families, too. Luciano’s father, Dr. Anthony Luciano, is also an OB/GYN at UConn Health, specializing in reproductive endocrinology and minimally invasive surgery.

“Initially I didn’t want to do anything he did — but the more I learned, the more I wanted to have that skill and expertise,” Luciano says.

She and he now work together; he is a member of the Center of Excellence for Minimally Invasive Gynecologic Surgery at UConn Health. She is the director.

Breastfeeding

If lactation is a superpower, nursing is an art.

If lactation is like a superpower — a woman makes milk, and it’s perfectly nourishing, antibacterial, immunity-boosting, and always exactly the right temperature — then nursing is more of an art, a skill women learn by observation or instruction.

But fairly often in the U.S., women have trouble with it, and end up pumping or formula feeding even if they’d rather nurse.

“Whenever we talk about breastfeeding it becomes a very hot and emotional conversation,” UConn nurse-scientist Ruth Lucas, Ph.D., RN, says. She wants to cool that conversation off with data.

Lucas spent 20 years working as a nurse and lactation specialist, “supporting mom in whatever way she can feed her baby and feel good about herself.” But the more she saw, the more she wondered why for so many women breastfeeding just didn’t work. So she turned to research, and her first project has zeroed in on pain during nursing. Why does it happen, and how can we help women who want to nurse but find it agonizing?

She’s finishing up a pilot study that tracked women who initiated breastfeeding, their experiences, and their gene variants that might be linked with pain. And that’s just the start. She’s also interested in the baby side of the equation: different babies approach breastfeeding differently. Does this affect mom’s pain? Does the pain change the breastmilk? Does that affect the babies?

“We all want to grow and nurture our children,” Lucas says. She wants to nurture the women, too.

Pelvic Health

Cultural taboos prevent patients from admitting that they have issues.

Lauren Brennan and Cathy Trahiotis want you to talk to your patients about peeing. And sex. Also bowel movements. Like, how often does your patient poop?

“If they say ‘once a week,' you know there’s a problem,” Brennan says, laughing. She’s a family nurse practitioner who works in the urology practice at UConn Health. Trahiotis is a physical therapist who specializes in women’s pelvic health. And they’re on a mission to educate people — and alleviate people’s fears — about incontinence and other pelvic problems.

Recent studies have found that almost half of adult women experience either stress incontinence — involuntary urination when coughing or exercising — or urge incontinence, when they feel the urge to urinate but can’t get to a toilet in time.

“But it’s not normal to have incontinence! We can treat it,” says Trahiotis.

Cathy Trahiotis and Lauren Brennan want docs to talk to patients about peeing. And sex.

She notes that for some women, pregnancy can be the start of pelvic issues. The heavy, swelling uterus presses on nerves in the pelvis, stretches ligaments, and separates the abdominal muscles (a condition called diastasis recti). After birth, if the abdominals don’t knit back together, it leads to weakness that can force the pelvic muscles to compensate, stressing them and potentially causing pubic pain or incontinence.

Fortunately diastasis recti can usually be cured with physical therapy. Other issues involving the pelvic muscles can be similarly healed through specific exercise, stretching, and diet.

In her urology practice, Brennan often sees patients with dyspareunia, or painful sex. It can often be treated. But it’s almost never the reason the patient made the appointment, Brennan notes. She always has to ask.

Both Brennan and Trahiotis say cultural taboos against discussing bodily functions prevent patients from admitting to their doctor that they have issues. So doctors should bring it up first. Ask patients directly: “How’s sex for you? Is it comfortable? Do you have any issues you’d like to talk about?” Ask about peeing and bowel movements. Or if your patients are super shy about discussing it, perhaps a written questionnaire would be better.

No matter how you do it, Trahiotis and Brennan say, the bottom line is “know about it, talk about it, don’t be afraid! And fix it without surgery!”

Dermatology

Sometimes she’ll point out something I can’t see. That’s when I reassure her.

The trick to drawing out a patient’s concerns about her skin is to hand her a mirror, says UConn Health dermatologist Dr. Mona Shahriari.
“Sometimes she’ll point out something I can’t see. That’s when I reassure her. I’m a trained dermatologist, and if I can’t see it, the world probably can’t, either.”

Dr. Mona Shahriari wants women to feel like at least once, they're being taken care of.

Shahriari has seen a lot. The year before she entered medical school, she volunteered to work with individuals exposed to radiation and chemicals during the Iran-Iraq War. They had a tendency to grow bizarre forms of skin cancer. Many of them would try to hide the growth and ignore it. And now, even though she’s practicing medicine on the other side of the planet with an entirely different population, some of her female patients have a similar problem.

“They’re so busy caring for their families they forget to care for themselves. Women often show up with undiagnosed skin diseases” they’ve been ignoring, says Shariari. When they finally do make it to her office, she gives them the time they need. Most of the time her women patients come to her with concerns about skin cancer, but there’s usually another underlying worry: aging.

“Society makes women very self-conscious about their appearance,” says Shahriari. And their skin is readily visible to the world. So she listens, and helps them. Ultimately, a patient may need bloodwork, a biopsy, laser treatment, or reassurance. But no matter what, “I make them feel like at least once, they’re being taking care of. Their concerns are the priority.”

Gynecologic Oncology

Some women say “I just can’t do this anymore.” But we have lots of options to help.

The patients keep her going. Many of the women are overweight. A lot of them have diabetes and high blood pressure. They don’t heal well; they’re greater surgical risks; they’re medically fragile. And yet, they keep going. And so does she.

Dr. Molly Brewer says getting cancer patients healthy and back to their lives makes the challenges of her job worth it.

Typically, the women are referred to her by primary care physicians, gynecologists, or emergency room doctors when the women show up with a suspicious lump in their abdomen, cervix, or vulva. Such patients are usually urgent, and Brewer always gets them into her office within a week or less. If they don’t have cancer, she sends them back to their regular doctor. But if they do have cancer, she cares for them from the beginning to the end, performing surgery to remove the mass, treating it with anti-cancer drugs, and helping them through into remission. She also cares for certain breast cancer patients who suffer from unique gynecological issues. Certain drugs used to prevent a recurrence of the cancer can cause vaginal atrophy because they suppress estrogen, for example.

“Vaginal atrophy makes sex really painful. Some women say ‘I just can’t do this anymore.’ But we have lots of options” to help, Brewer says.

Her research centers on ovarian cancer and new technologies to diagnose it. She and her partner, newly arrived gynecologic oncologist Dr. Bradford Whitcomb*, are currently enrolling patients for an ovarian cancer vaccine study.

She chose gynecologic oncology because she loves it, and she loves it because of the patients. The challenge of taking care of women with difficult cancers, and the inspiration of watching them make
it through.

“When we get them into remission, they’re healthier, they feel better, they’re able to go back to their life. And that makes it all worth it.”

Each patient also has access to a vast group of UConn Health’s multi-specialists, cutting-edge clinical research trials, and support services.

“It is so important to me to treat each of my patients like my own family member with the most personalized, comprehensive patient care experience, and the kindest and gentlest approach,” Whitcomb says. “It is so personally satisfying to me to have the ability each day to help women and their families through their cancer diagnosis and care.”

Whitcomb is a retired U.S. Army Lt. Colonel who served in the Army Medical Department for more than 25 years. He also was deployed several times in Iraq and Afghanistan as an OB/GYN, surgical assistant, and combat research team member.

It is important to me to treat each of my patients like my own family member.

— Dr. Bradford Whitcomb, UConn Health gynecologic oncologist

“The Army was a conduit for me to attend medical school and have the privilege to care for women my entire career,” says Whitcomb. “Women run our families. It’s critical for women to remain healthy and team with their doctors to ensure they are having their annual primary care and GYN screenings, which are the basis for preventing illness and catching a female cancer early.”

According to Whitcomb, most gynecological cancers have early warning signs that women need to stay ahead of with their doctors. These may include unusual bleeding, abdominal pain, bloating, and difficulty eating. Other concerns include increased risks of endometrial or uterine cancer as obesity rates among women rise, as well as making greater efforts to increase cancer screenings among underserved female populations.

But Whitcomb reports the biggest challenge in gynecologic oncology is still preventing and catching ovarian cancer, the most lethal cancer in women, early. He is currently working with Dr. Pramod Srivastava, director of the Neag Comprehensive Cancer Center, to recruit newly diagnosed ovarian cancer patients to the world’s first clinical trial testing a unique genomics-driven immunotherapy vaccine aimed at preventing the disease’s recurrence.

“Bottom line, to beat female cancers we need open lines of communication with both referring primary care and OB/GYN physicians, and women need to feel comfortable reaching out directly for consultation,” Whitcomb says. “Don’t hesitate to make that call. The UConn Health family is here to help.”

Ovarian cancer relapses are deadly. UConn Health is testing its pioneering vaccine that could prevent them.

The experimental vaccine, named OncoImmunome, is administered as a simple injection in an outpatient setting. It works by boosting the patient’s immune response to enable it to destroy ovarian cancer cells, so that they do not resurface.

The genetic differences between the surface proteins on a patient’s healthy and cancerous cells constitute the fingerprint of that particular patient’s cancer, which is unlike the fingerprint of any other person’s cancer. Based on these variations, scientists create the personalized vaccine.

“This is the first vaccine of its kind developed for women diagnosed with advanced ovarian cancer,” says Dr. Pramod K. Srivastava, the vaccine’s developer, who is a leading cancer immunotherapy expert and director of the Carole and Ray Neag Comprehensive Cancer Center at UConn Health. “The personalized vaccine is specifically created using a patient’s own genomics information to prevent an often life-threatening recurrence of the disease and extend survival.”

There is no early-screening test for ovarian cancer. When a woman with the disease starts to actually experience non-specific abdominal symptoms such as bloating, the disease has often already advanced to stage III or stage IV cancer. Further, there is no effective long-term treatment for ovarian cancer. Even after a woman is successfully treated with traditional surgery and chemotherapy, the disease has a very high recurrence rate within just two years. Tragically, most women die within five years of their diagnosis.

But Srivastava believes that appropriate immunotherapy may stop an ovarian cancer diagnosis from becoming a death sentence.

“There is a huge need for a therapy to actually prevent recurrence in these women and I believe our approach to a vaccine may be just the tool to do it,” says Srivastava.

In October 2014, Srivastava published a study showing that his promising approach to cancer vaccines is effective in reducing tumor growth and in preventing cancer progression in mouse models. Based primarily on that work, the FDA approved testing of the experimental therapy in a human clinical trial.

The individualized vaccine is created using samples of a patient’s own DNA from both her unhealthy cancer cells and her healthy blood cells. Over a period of about two weeks, scientists sequence and cross-reference the entire DNA from both sources to pinpoint the most important genetic differences. These genetic differences constitute the ID card, or fingerprint, of that particular patient’s cancer, which is unlike the ID card or fingerprint of any other person’s cancer. Based on the cancer’s fingerprint, bioinformatic scientists, led by Ion Mandoiu of UConn’s School of Engineering, design the personalized vaccine that is meant to target the cancerous cells’ specific genetic mutations.

UConn Health’s new clinical trial will initially enroll 15 women with stage III/IV ovarian cancer and track them closely for two years, the window of time when recurrence most often occurs. Candidates for the clinical trial are women recently diagnosed with advanced ovarian cancer who will have traditional surgery and receive chemotherapy. If cancer-free three months after traditional treatment, the women will receive their personalized vaccine injections once a month for six months. Also, each month their blood will be drawn and evaluated for immune response.

“Our clinical trial will be testing the vaccine for safety and feasibility, but also will be testing whether the vaccine is making a real difference in patients’ blood; the timing of recurrence of cancers in these patients will also be monitored,” says Srivastava. “If, after receiving the vaccine, their cancer hasn’t recurred for a long time in a substantial proportion of women, we will know that the vaccine is promising.”

In October 2014, Srivastava published a study showing that his approach to cancer vaccines is effective in reducing tumor growth and in preventing cancer progression in mouse models. Based primarily on that work, the FDA approved testing of the experimental therapy in a human clinical trial.

Dr. Angela Kueck, assistant professor of gynecological oncology, and Dr. Jeffrey Wasser, assistant professor of medicine at the Carole and Ray Neag Comprehensive Cancer Center, are the principal and co-investigators of this study.

“We have received over a hundred messages from women in Connecticut and from around the world, in the hope of participating in our study,” says Srivastava.

He adds, “The most meaningful part of my life, at this time, is to serve. I hope that our results a few years from now will show that our unique ovarian cancer vaccine can prevent recurrence of the disease and even extend survival.”

If the clinical trials are successful against ovarian cancer, Srivastava plans to expand testing of his vaccine to bladder cancer and other solid-tumor cancers.

Researcher spotlight

Dr. Pramod Srivastava Honored For Groundbreaking Cancer Research

Dr. Pramod K. Srivastava, director of the Carole and Ray Neag Comprehensive Cancer Center, will be honored at the 7th Annual White Coat Gala to benefit UConn Health on April 16 at the Connecticut Convention Center in Hartford.

The annual event honors the men and women in “white coats” who are breaking new ground in the lab and providing exceptional patient care.

Srivastava will receive the 2016 Carole and Ray Neag Medal of Honor for his contributions to the fight against cancer, along with co-honoree Bess Economos, co-founder of Lea’s Foundation for Leukemia Research.

“I am honored to be recognized by UConn,” says Srivastava. “This award is particularly meaningful to me, personally, because it bears the names of Carole and Ray Neag, whose selfless service makes a difference in the lives of thousands of patients facing cancer as well as other diseases.”

Highly accomplished in both basic and translational research, Srivastava is leading the world’s first clinical trial for an ovarian cancer vaccine using patients’ own genomics, or DNA. He has earned international acclaim for his groundbreaking work in the immunological function of heat shock proteins and in cancer immunology, is widely published in scholarly journals, and serves on the editorial boards for several major journals in immunology.

In addition, Srivastava in December was elected a Fellow of the National Academy of Inventors (NAI) for his long-standing inventions in the area of cancer immunotherapy, including his promising vaccine for difficult-to-treat ovarian cancer.

The White Coat Gala, supported by founding title sponsors Richard and Jane Lublin and other top sponsors, has raised more than $3.5 million for UConn Health. The event celebrates UConn Health’s eminent physicians, dentists, and researchers who are translating discoveries made in the lab into lifesaving advances.